Fatty Liver Disease is the silent epidemic with staggering implications sweeping the nation as we speak. It’s going to be America’s most pressing health issue. In many experts’ mind it absolutely is already. According to the Liver Foundation: 100 million people have Non-Alcoholic Fatty Liver Disease(NAFLD). This is a big deal. 1 in 3 people suffer from this easily preventable yet utterly prolific disease. Compound this with America’s love for alcohol and we’ve got ourselves a pretty serious liver problem to deal with as a society.
This is extremely concerning and since it’s so innocuous it doesn’t get the press it direly needs. Let’s get to talking about it and shed a serious spotlight on one of the most worrying, least talked about disease in America today.
So what is the science behind preventing and more importantly reversing this disease?
How do we use this science to get us one step closer to that pristine health that we all desperately seek?
That’s what we we’re going to address in this article.
It’s important to note that fatty liver itself doesn’t necessarily have inflammation involved with it. But don’t let that marginalize the seriousness of the issue. When inflammation of the liver gets involved it’s considered a “separate” issue which is known as steatohepatitis. About 20% of people with inflammatory symptoms manifest with NAFLD, which the medical community calls Non-Alcoholic Steatohepatitis(NASH).
But the simple fact of the matter is we shouldn’t have more than 5-10% fat, unless you have some interesting genetics. Going above this general limit is a precursor for NASH(if it’s not already happening), and an inflamed liver means an overworked liver.
I like to think of the liver as my body’s own little personal guardian. Even if you are without symptoms… why risk it if you don’t have to?
As stated from sciencedaily.com:
“Fatty liver causes morbidity and mortality due to metabolic complications such as diabetes and cardiovascular disease, the development of cirrhosis and liver cancer.”
Even though the main mechanisms behind what causes NAFLD and ALD(alcoholic liver disease) are different, the result is the same: an overtaxed, stressed out liver. The two problems are intrinsically interwoven. Just because someone isn’t an alcoholic doesn’t mean that damage to the liver is not already occurring.
The liver is amazingly resilient and is capable of functioning despite all of the abuse one can give it, even if it’s a ridiculous amount. This is a double-edged sword, because even if we beat it up we can still use it thankfully. Not being able to see symptoms manifest allows us to throw caution to the wind unfortunately. The symptoms might not show up until it’s too late, and you could be facing a liver transplant or a serious uphill battle to get back to par.
As the old saying goes- It really is best to mind your P’s and Q’s(pints and quarters;).
The main cause of what is thought to be burdening the liver the most in Non-alcoholic Fatty Liver Disease is pretty straight forward: Choline Deficiency.
-So even if you aren’t having symptoms of this deficiency(yet, at least) that doesn’t mean that you aren’t deficient in this lesser known but super beneficial B Vitamin. Egg yolks and liver are the two most abundant sources of this nutrient.
This differs from the main stressors that alcoholics face when it comes to Alcoholic Liver Disease: B6, B12(Cobalamin), and Folate deficiencies. These nutrients are the main co-factors in the Methionine cycle.
-There are some other issues as well going on here like Zinc and Magnesium depletion which are being explored, and new genetic pathways being found that are show promise for treating and understanding even more of the mechanisms involved with ALD.
The focus of this article is going to be limited to the alcohol aspect of liver health. The main ideas to be emphasized are B Vitamins, Methylation and Glutathione(GSH). These components are all interwoven with each other since it’s a cycle, but it is helpful to break some of it down separately for easier understanding. Alcohol’s disruption of this cycle leads to elevated levels of Homocysteine because the liver can’t convert Homocysteine into Methionine due to the depletion of nutrients that are necessary to make this go down.
High levels of Homocysteine in the blood are correlated to inflammation, heart disease, and stroke.
Alcohol and Methylation
Methylation is a very important part of detoxification and repairing your DNA, it also helps regulate mood.
Methylation, simply put is just the process of adding a methyl group(carbon group) to substances to help get them ready for detoxification or aid in a myriad of other essential bodily processes.
So that begs the question:
What can one do as a responsible drinker to make up for the damage being caused by inhibition of Methylation?
Well, the first answer is an obvious one: drink less.
Aside from that, we can look at chronic alcoholics to see what damage alcohol is doing in the long-term and how it’s putting a strain on the liver through the Methionine metabolism.
What’s going on with full blown alcoholism might not be 100% relevant to your or my current drinking habits but it gives us a pretty solid hint as to what we should most likely be concerned about.
As it turns out, if we follow this logic then we should probably be concerned about those three B Vitamins mentioned earlier. Methylation involves Methylfolate, Vitamin B6 and Vitamin B12. It’s not surprising that alcoholics are commonly found to be very deficient in Vitamin B9(Folate). Inversely, it should be noted alcoholics have higher serum levels of B12 because the liver isn’t capable of keeping the B12 stores anymore so it floats loosely in the blood.
Time and time again Folate deficiency and alcoholism have been linked to each other. That is because of the way the liver processes alcohol. Becoming aware of this is an advantage because you can end up taking some simple precautions.
Awareness of this this may just serve you well in the long term and quite possibly have immediate benefits such as avoiding a dreaded hangover. Hangovers are very complex, still.. it’s just one piece of the puzzle. Understanding this process can also be beneficial at the very least in the long run, especially compared to those who remain unconcerned.
And, consider this… people who drink should concern themselves with things like this. These nutrients are being depleted and as depletion occurs they can end up creating a really nasty feedback loop.
This loop involves malabsorption and damaged cells which just keeps feeding problems into itself. The cells get damaged and can’t function and then can’t uptake the things they need to function, creating unnecessary amplification. This can be difficult to work back from. How does one shield oneself from the many negative impacts associated with alcohol? A clearing understanding of what’s going on with underlying mechanisms such as how the body processes toxins is critical.
Just a quick side note to ponder when it comes to B Vitamins:
-They love water. One of the most well known effects of alcohol other than questionable choices involving exes, is that it is a diuretic. It suppresses our water-preservation hormone vasopressin. So when you inevitably end up breaking that proverbial seal and the floodgates open, extra damage is being done to this cycle and your body. You end up peeing out all these valuable nutrients that could’ve otherwise come to your aid.
Since alcohol puts such a stress on the B Vitamins and ends up disrupting the Methylation process by draining your body’s stores of Methylfolate and B12 to produce Methionine & S-Adenosyl Methionine(SAMe). It’s my opinion that these B Vitamins are a solid place to start looking at for ways to help us mitigate the damage, and start trying to control this issue before it gets too big to handle.
It’s important here to note that Betaine can come in and aid with handling liver injury as well. So if you like beets you can stock up on those or you can try utilizing more betaine HCl to help aid with digestion especially if you have heartburn due to low stomach acid or nutrient absorption issues.
In an animal model involving Betaine and alcohol, it was shown to help preserve SAM, lower Homocysteine levels and prevent injury due to oxidation; which is not only very promising but also very logical. Honestly, it’d be more surprising if Betaine didn’t help. The more I learn about beets and Betaine, the bigger fanboy I become of both of them.
As for how to ensure more Folate and B12 to hopefully keep this cycle going without interruption. My personal favorite sources of Folate and B12 are: liver pate(can’t stand liver by itself but the patè is so good) for both Folate and B12 and leafy greens(folate stems from the word foliage).
Supplementation might be prudent, especially Methylfolate. Since a lot of the enzymes involved can get depleted quickly trying to convert Folate or Folic Acid into Methylfolate to keep this cycle going, Methylfolate is what ends up donating the methyl group to help with Methylation cycle. If your body runs low on these enzymes it doesn’t matter how much Folate or Folic Acid you have, so sometimes it’s just easier to give the body what it needs in supplemental form.
It seems pretty logical to use Methylcobalamin as the preferred source of B12 since it has a methyl group already attached to it. That way you get to preserve those precious carbons.
-The fact that B12 taken orally has a very low bioavailability is one thing to keep in mind when using it to possibly shield against the problematic effects that come with all that imbibing.
Methylation also serves a role in regulating Norepiniphrene, Dopamine and Serotonin
Without Methylation playing a role in this area, things can get out of balance in the emotional department. I’m sure we can all account to seeing that happen more than once.
Dr. Ben Lynch has a theory that this might be the cause of angry drunks.
Alcohol and Glutathione Depletion
Alcohol depletes Vitamin B6. B6 plays an essential and active role in forming Glutathione(GSH). [pictured at the bottom]
Glutathione is critical for a ton of reasons. You’ll hear it constantly said that it’s your body’s “master antioxidant”. It’s essential for healing your liver from damage and cleaning up ROS(reactive oxygen species) before they can do damage. The more Glutathione you can maintain, preserve and generate most likely the better off your cells will be. Thus, the better off you will be. The less you’ll need to worry about your personal guardian the liver.
Alcohol forms not only ROS but also Reactive Nitrogen Species(RNS). In turn both ROS and RNS end up being a cause oxidative stress.This puts an intense workload on Glutathione to give away its precious electrons and is quite possibly one of the bigger factors behind the liver damage caused by alcohol.
Since alcohol ends up putting so much excess strain on the body and the liver uses Glutathione to donate its electrons and help clean up that mess. It might be a wise choice to figure out ways to help preserve and replenish Glutathione.
Nutritional Glutathione Support
- Vitamin C is a cheap, abundant and critical vitamin that acts as an antioxidant and can actually help preserve Glutathione found in red blood cells due to the fact that it will end up donating electrons before Glutathione. It’s challenging to get useful amounts Vitamin C from food, and you definitely could consider trying to get vitamin C from fruits and things like parsley as they have a considerable amount of other beneficial nutrients and antioxidants in them as well.
Beware though, if you have any sort of disease that causes you to uptake too much iron. You should be use caution with vitamin C because it’ll enhance iron uptake. Although one way you might consider getting the benefits of higher dosages of Vitamin C while reducing iron uptake is exercise. This was just recently exhibited in a study that looked to see if they could reduce liver fat through resistance training.
Spoiler alert: it did. It also reduced levels of Ferritin, which is an enzyme involved in uptake and storage of iron. Excess iron can lead to a lot of complications, but that discussion is for another day.
Milk thistle is also another great tool to have in your kit, due to its Silymarin/Silybin content. It is probably one of the most beloved herbs by anyone that’s concerned about their liver, especially when it comes to drinking. And for good reason.
It’s well studied and has a low toxicity, so in other words- very little risk with a chance at high reward in the long run. Milk thistle seems to have an amazing capability of helping to normalize Glutathione levels even after alcohol wears down your precious reserves.
It also acts on the Nrf2 pathway(also known as NFE2L2) much like leafy greens and is synergestic with Ashwagandha in regard to Nrf2 activation, which is also a helpful friend to have when it comes to protecting your body.
Magnesium. Magnesium is just badass in general. But it also plays a role in the synthesis of Glutathione. Supplementation has shown that it does in fact increase Glutathione levels and shows antioxidant activity. So many people are deficient in this vital mineral. Supplementation of it is wise.
The amino acid chelates of Magnesium(Glycine probably being the best chelate) are the most bioavailable and they don’t act as a laxative, so you don’t have to worry nearly as much about over doing it and your body can use what it needs.
Some people really like Magnesium Threonate for it’s ability to cross the blood brain barrier. Compared to other Magnesium’s it can be objectively pricey though. For those on a budget, Magnesium Citrate is a great option. But since it’s a saline laxative try to split your dosages up(200 mg in the morning and 200 mg at bedtime is how I use Mg Citrate).
Magnesium also aids with sleep which is a total bonus since alcohol inherently disrupts sleep and worsens its quality. Since alcohol acts as a diuretic, you can end up losing a lot of magnesium just due to excess peeing.
Turmeric. It will help enhance your Glutathione reserves. Turmeric contains Curcumin and Ar-turmerone.
Ar-turmerone enhances the bioavailability of Curcumin and has it’s own beneficial effects. Turmeric is definitely a favorite when it comes to taking care of your liver. Piperine will also increase it’s uptake by turning off a pathway that blocks it’s uptake(the liver views it as a toxin otherwise :().
One nice thing as about using Turmeric as a drinking buddy is Curcumin, the most studied bioactive in turmeric happens to be alcohol soluble(it’s also fat-soluble too).I personally prefer buying bulk powder of Turmeric because it has a ton of other bioactive compounds that are less-studied and I’m a fan of Ar-Turmerone.
Plus it is just cost-efficient.You can use it in baking and cooking, unlike Curcumin.
However Turmeric has a strong affinity for soaking up lead in the soil. Purchasing supplements while being more expensive can help ensure against lower levels of lead if they’re from a manufacturer that is cGMP certified(most brands on amazon and in your store should be..).
If you want to use just straight up Curcumin, which has a low bioavailability make sure to find something like this that uses Piperine and if you can find one with a carrier oil, that’ll help too.
You can easily just eat a little bit of coconut oil with it. In animal studies it has prevented and reversed cirrhosis(scarring) caused by fatty liver injury. A Curcumin based trial has shown that it reverses NAFLD in humans. Just a wonderful spice all around.
Vitamin B6. As mentioned previously, alcoholics are deficient in this critical vitamin that’s essential for Glutathione production.
Look for Pyridoxal-‘5-Phosphate(p5p) if you want to supplement since that is it’s active form so you don’t have to waste enzymes to utilize it.
- Beef(preferably grass-fed if possible)
- Sunflower Seeds- which makes for a good peanut butter substitute since peanut butter is notorious for aflatoxins due to shady brands using moldy peanuts
- Tuna(beware of BPA and mercury, selenium binds to mercury and keeps it from absorbing or consider tuna that is checked for mercury if you just gotta have that tuna salad)
The importance of working with your Liver
So if you’re going to work against your liver with the use of alcohol, you should most definitely want to work with it as well.
Understanding just the process of methylation and its relationship to alcohol will hopefully aid you in the battle of against becoming “The One in Three” that have to deal with Fatty Liver Disease. There are other factors involved with alcohol detoxification but this is a very solid starting point as methylation is one of the most ubiquitous processes going on in the body.
It’s so much bigger than just alcohol. It sits at the heart of our DNA and mood, as well, I can’t emphasize that point enough.
Really love that study involving resistance training and reducing fatty liver, because resistance training can be far less time consuming than cardio and is almost undoubtedly way more effective for the heart than traditional cardio routine.
Exercise also improves sleep quality by allowing tryptophan to not have to compete to cross the blood-brain barrier. So if you’re going to enjoy all the wonderful benefits of alcohol, consider adding the benefit of exercise in there as well. Exercise also has so many psychological, social and biological rewards.
Diet is very critical and almost always preferred to supplementation, but there are definitely areas in which supplementation proves useful and that can’t be denied. Especially when it comes to a population that’s so deficient in so many basic things and also loves to have fun. It’s almost always worth considering the use of effective nutrients, Nootropics, Adaptogens and beneficial herbs to help mitigate some of the damage done by the fun.
I’m personally emphatic about utilizing things like Vitamin C, Magnesium, Milk Thistle and Ashwagandha(this list could go on and on).
-As much as I’d love to stay pristine, it’s not realistic and it’s not all that fun. So I find supplementation to help mitigate some of my more questionable choices. I’m personally in the camp where I think it’s silly to separate supplementation and diet and just say, “why not both?”
Hope you found a lot of useful takeaways from this. It’s a lot to take in, but just incrementally making steps towards improving your liver function can have profound benefits.
Little changes over time can bring immense benefits down the road and almost always have some immediate benefits. Hopefully you can gain some peace of mind by knowing some of the most fundamental aspects of alcohol metabolism and they can help you feel more confident if you’re concerned about bringing a balance to your social life.
We consider it a worthy pursuit to try and shield against against the damaging effects of alcohol through diet/supplementation/lifestyle. It is totally worth the effort of just making a few changes to routine when possible.
The more you drink the more relevant these issues become and due to the feedback loop mentioned earlier. The more often you drink and the harder you drink, the harder it is to treat because you’re downregulating gene expression. You’re already burnt on nutrients and enzymes, the liver is messed up.. mitochondria suffer in turn and then the body has to deal with other lingering effects caused by your liver not being able to do its job in other areas and the immune system being overloaded.
Prevention is most definitely better than cure.
Alcohol is disruptive to digestive processes and is correlated with SIBO, so don’t think just because you’re eating food high in these nutrients that you know are being depleted that you’re magically in the clear.
Still, something is better than nothing and quite possibly(hopefully) a lot better.
Keep in mind nothing is a silver bullet at this point and time and you should always limit stuff as toxic as alcohol.
Sometimes that’s not always realistic for everyone and every situation. Do what you can with what ya got. I just know from past experience that I’ve used my knowledge to justify partying harder to my own chagrin; try to avoid that trap if possible ;).
Diet and nutrients aren’t everything, they’re just a start and the easiest changes to make. They help get the ball rolling and can help you build a lot of momentum in creating health.